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THE EFFECT OF HOT FOMENTATION ON
THROMBOPHLEBITIS AMONG PATIENTS RECEIVED
INTRAVENOUS THERAPY
\
A dissertation submitted to
THE TAMILNADU DR.M.G.R .MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILLMENT OF THE REQUIREMENT
FOR THE AWARD OF DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2015
THE EFFECT OF HOT FOMENTATION ON
THROMBOPHLEBITIS AMONG PATIENTS RECEIVED
INTRAVENOUS THERAPY
Certified that this is the bonafide work of
Reg.No: 301311702
MEDICAL AND SURGICAL NURSING
THANTHAI ROEVER COLLEGE OF NURSING
PERAMBALUR
COLLEGE SEAL:
SIGNATURE : _________________________________
Prof.R.PUNITHAVATHI. M.Sc.,(N),
Principal,
Thanthai Roever College of Nursing,
Perambalur.
A dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2015
THE EFFECT OF HOT FOMENTATION ONTHROMBOPHLEBITIS AMONG PATIENTS RECEIVEDINTRAVENOUS THERAPY AT SELECTED HOSPITALS
TITTAGUDI.Approved by Dissertation
committee on : ______________________________________
Research Guide : ______________________________________ Prof.R.PUNITHAVATHIM.Sc.,(N),
Principal
Thanthai Roever College of Nursing,
Perambalur
Clinical speciality guide : ______________________________________
Prof. V.J.ELIZABETH M.Sc (N).
Vice Principal,
Thanthai Roever College of Nursing,
Perambalur.
A dissertation submitted to
THE TAMILNADU DR.M.G.R .MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE AWARD OF DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2015
INTERNAL EXAMINER EXTERNAL EXAMINER
DECLARATION
I, 301311702hereby declare that this dissertation entitled “A STUDY TO
ASSESS THE EFFECTIVENESS OF HOT FOMENTATION ON
THROMBOPHLEBITIS AMONG PATIENTS RECEIVED INTRAVENOUS
THERAPY AT SELECTED HOSPITALS TITTAGUDI” has been prepared by
me under the guidance and direct supervision of Prof.R.PUNITHAVATHI, M.Sc(N),
Principal, Thanthai Roever College of Nursing, Perambalur, as requirement for partial
fulfilment of M.Sc Nursing degree course under The Tamilnadu Dr. M.G.R. Medical
University, Chennai – 32. This dissertation had not been previously formed and this will
not be used in future for award of any other degree / diploma. This dissertation represents
independent original work on the part of the candidate.
Place : Perambalur 301311702
Date : April – 2015 II Year M.Sc (N) Student
Thanthai Roever College of Nursing
Perambalur.
ACKNOWLEDGEMENT
In a life intimately enmeshed in a web of relationships with huge cosmos, it is
difficult for me to leave anyone unacknowledged for their direct or indirect
influence on me in shaping up of this thesis to its current existence.
I hereby offer my heartfelt gratitude to the King of kings and the Lord
of lords , the Almighty God who makes all things beautiful in His own
time. His grace and blessing was my strength throughout this study.
I express my sincere gratitude to Dr. K. Varadharaajen, BA.,BL., Chairman
and Managing Trustee, Thanthai Roever College of Nursing, Perambalur for
providing me an opportunity to pursue this Post Graduate programme in this
esteemed institution. I express my thanks to him for his encouragement and
support.
I would like to express my gratitude to Prof.R.Punithavathi M.Sc(N)
Principal, Thanthai Roever College of Nursing, for her valuable guidance,
constant encouragement and enlightening ideas which enabled me to accomplish
this task.
I am extremely grateful to Prof. Mrs. V.J. Elizabeth., M.Sc. (N), Vice
Principal Thanthai Roever College of Nursing who gave me valuable
suggestions, which helped to modify and enrich my research.
I am grateful to all the experts for their sincere efforts in validating my tool.
I express my words of appreciation to Mr. Venkataraman M.Phil.,
Statistician, for his guidance and suggestions in the statistical analysis of the data.
My gratitude to Mr. S. Kameswaran, M.L.I.S., M.Phill., librarian of
Thanthai Roever College of Nursing and all the library staffs of Tamilnadu Dr.
M.G.R. Medical University, Chennai for their support and guidance in procuring
the literature related to the study.
It is my immense pleasure to express my heartiest gratitude to my family
members, Mr.R.Mahendran my dear Husband for his moral support and priceless
encouragement, Mrs.R.Asalambal my dear mother in law for her kind
unconditional help, love and encouragement. I am extremely thankful to
Mrs.Dhanalakshmi my sister took care my child during study period.
Last but not the least I m indebted to participants of this study who despite their
innumerable sufferings, have whole heartedly participated and co-operated with
me in this study, without them this research might not be possible.
As a final note I, the investigator, owe a deep sense of gratitude to all those
who have directly or indirectly contributed to the successful completion of this
endeavor.
THE EFFECT OF HOT FOMENTATION ON THROMBOPHLEBITISAMONG PATIENTS RECEIVED INTRAVENOUS THERAPY AT
SELECTED HOSPITALS TITTAGUDI
ABSTRACT
INTRODUCTION:
Thrombophlebitis is viewed as a natural consequence of routine intravenous
therapy. Any form of injury to a blood vessel can result in thrombophlebitis. In
intravenous thrombophlebitis, the blood clot usually attaches firmly to the wall of the
affected vein. Moist heat fomentation is a topical treatment of pain or inflammation .
OBJECTIVE
To assess the effectiveness of hot fomentation on thrombophlebitis among patients
received intravenous therapy.
METHOD
Study design was true experimental pre-test and post test control group design.
Sixty individuals with thrombophlebitis were recruited by simple random sampling
technique in to two groups and pre test was done. Experimental group(n=30) received
hot fomentation intervention over the site of thrombophlebitis for 15 minutes, morning
and evening 2 times a day for 3 days was done. Post test was done with the modified
visual infusion phlebitis scale on the fourth day for both groups.
RESULT
Statistical findings revealed that the post test mean score of thrombophlebitis in
experimental group was 5.80 with S.D 0.85 whereas in the control group was 9.37 with
S.D 1.52. The mean difference was 3.57 and the calculated unpaired‘t’ value of
t = 11.229 was found statistically significant at p<0.001 level.
CONCLUSION
The use of hot fomentation is effective in reduction of thrombophlebitis among
patient received intravenous therapy.
TABLE OF CONTENTS
CHAPTER NO TITLE PAGE NO
I INTRODUCTION 1
Need for the study 2
Statement of the problem 4
Objectives of the study 4
Research hypothesis 4
Operational definitions 4
Assumptions 5
Delimitations 5
Projected outcome 5
II REVIEW OF LITERATURE.
Related Studies 6
Conceptual frame work 11
III METHODOLOGY
Research approach 14
Research design 14
Variables 15
Setting of the study 15
Population 15
Sample 15
Sampling technique 15
Sample size 15
Criteria for sample selection 16
CHAPTER NO TITLE PAGE NO
Development and descriptive of the
data collection tool 16
Content validity 17
Reliability 17
Pilot study 17
Collection of data 18
Plan for data analysis 18
Ethical consideration 19
Schematic representation of research 20
IV DATA ANALYSIS AND
INTERPRETATION 21
V DISCUSSION 42
VI SUMMARY 44
Major findings of the study 45
Implications 47
Recommendations 49
Conclusion 49
REFERENCES 50
ANNEXURES I-VII
LIST OF TABLES
TABLE NO TITLE PAGE NO
1 Frequency and percentage distribution of
Demographic variables of the patients
received intravenous therapy in
experimental and control group. 22
2a pre and post test level of thrombophlebitis among
patients received intravenous therapy in
Experimental group. 29
2b pre and post test level of thrombophlebitis
among patients received intravenous
therapy in control group. 31
3a Comparison of pre and post test mean score
of thrombophlebitis among patients received
intravenous therapy in experimental group. 33
3b Comparison of pre and post test means score
of thrombophlebitis among patients 35
received intravenous therapy in control group.
3c Comparison of mean thrombophlebitis score
of post test among patients received
intravenous therapy between the
experimental and control group. 37
4a Association of post test level of
thrombophlebitis among patients received
intravenous therapy with their selected
demographic variables in the experimental group. 39
LIST OF ANNEXURES
ANNE
XURE
NO
TITLE
P
AGE
NO
I
Letter seeking expert’s opinion for content
validity
permission
i
II List of expert’s opinion for content validity ii
III Evaluation criteria checklist for validation iiiIV Permission letter for research purpose ivV Informed consent form (English) vVI Informed consent form (Tamil) vi
VII Data collection toolvi
i
LIST OF FIGURES
FIGURE NO TITLE PAGE NO
1 Conceptual frame work based on General system theory 13
2.1 Percentage distribution of body mass index among thepatients in the experimental and control group 26
2.2 Percentage distribution of the size of cannulaamong patients in the experimental group 27
2.3 Percentage distribution of history of chronic diseaseamong the patients in the experimental and control group 28
3.1 Percentage distribution of pre and post test levelof thrombophlebitis among patients receivedintravenous therapy in experimental group 30
3.2 Percentage distribution of pre and post testlevel of thrombophlebitis among patientsreceived intravenous therapy in control group 32
4.1 Comparison of pre and post test mean scoreof thrombophlebitis among patients receivedintravenous therapy in experimental group 34
4.2 Comparison of pre and post test mean score ofthrombophlebitis among patients receivedintravenous therapy in control group 36
4.3 Comparison of post test thrombophlebitis meanscore of the experimental and control group 38
ANNEXURE I
LETTER SEEKING EXPERT’S OPINION FOR CONTENT
VALIDITY
From
301311702
M.sc (Nursing) II Year,Thanthai Roever College of Nursing,Perambalur.
To:
Respected Sir/Madam,
Sub: Requisition for content validity of tool.
I am doing M.sc (Nursing) II Year in Thanthai Roever College of Nursing, Perambalur,
under The Tamilnadu, Dr.M.G.R. Medical University, Chennai. As a partial fulfillment
of my M.Sc. (Nursing) Degree programme, I am conducting a research on A study to
assess the effectiveness of hot fomentation on thrombophlebitis among patients
received intravenous therapy at selected hospitals tittagudi”. A tool has been
developed for the research study. I am sending the above stated for your valuable
opinion, I will be thankful for your kind consideration. Kindly return it to the
Undersigned.
Thanking you
Place: Yours sincerely,
Date: 301311702
ANNEXURE II
LIST OF EXPERTS OPINION FOR CONTENT VALIDITY OF
RESEARCH TOOL
1. Dr.Kolanchinathan MBBS., Dip.Diab
Reg no: 88062Medical Officer,Sai Dhanvanthiri Hospital,Tittagudi.
2.Dr. S. Rajina Rani M. Sc. (N), Ph.D,
Principal,Doctor’s College of Nursing,Pudukkottai.
3.Prof .R. Punithavathi M. Sc. (N), Ph.D,
Principal,Thanthai Roever College of Nursing,Perambalur.
4.Prof. V.J. Elizabeth M. Sc. (N),
Vice Principal,Thanthai Roever College of Nursing,Perambalur.
5.Mrs. Dhanalakshmi M. Sc. (N),
Associate professor,HOD of Medical Surgical Nursing,Dhanalakshmi College of Nursing,Perambalur.
6.MS.Shanthi M.Sc.(N) Reader,
HOD of Medical Surgical Nursing,Dr.G.Sakunthala College of Nursing,Murungapettai,Mutharasunallur, Trichy.
ANNEXURE III
EVALUATION CRITERIA CHECK LIST FOR VALIDATION
INTRODUCTION
The expert is requested to go through the following criteria for evaluation. Three
columns are given for responses and a column for remarks .Kindly place tick mark in the
appropriate column and give remarks.
INTERPRETATION OF COLUMN:
Column I : Meets the criteria
Column II : Partially meet the criteria
Column III : Does not meet the criteria
S.No Criteria 1 2 3 Remarks
1
Scoring• Adequacy• Clarity• Simplicity
2
Content• Logical sequence• Adequacy• Relevance
3
Language• Appropriate• Clarity• Simplicity
4
Practicability• It is easy to score• Does it precisely• Utility
Signature : Any Other Suggestion
Name :
Designation :
Address :
ANNEXURE IV
PERMISSION LETTER FOR RESEARCH PURPOSE
From
301311702
M.Sc., (Nursing) II Year,
Thanthai Roever College of Nursing,
Perambalur.
Through
The Principal,
Thanthai Roever College of Nursing,
Perambalur.
To
The Medical Officer
Tittagudi Sai Thanvanthiri Hospital
Tittagudi.
Respected Madam/Sir,
I am doing M.Sc., (Nursing) II year in Thantha iRoever College of Nursing
Perambalur. Under the TAMILNADU Dr.M.G.RMEDICAL UNIVERSITY,
CHENNAI. As a partial fulfillment of my M.Sc., (NURSING) Degree Programme, I am
going to conduct “A Study to assess the effectiveness of hot fomentation on
thrombophlebitis among patient received intravenous therapy” at Selected Hospital
Tittagudi. I would like to conduct the data collection at your esteemed institution. Hence,
I kindly request you to kindly grant me permission to conduct my study in our Hospital.
Thanking you
Place: Yours sincerely,
Date: 301311702
ANNEXURE V
CERTIFICATE OF ENGLISH EDITING
TO WHOMSOEVER IT MAY CONCERN
This is to certify that Reg No: 301311702, II- Year M.sc [Nursing] Student
of Thanthai Roever college of Nursing has done a dissertation study on “A Study
to assess the effectiveness of hot fomentation on thrombophlebitis among
patient received intravenous therapy” at Selected Hospital Tittagudi.This study
was edited for English language appropriateness.
Signature
ANNEXURE VII
DATA COLLECTION TOOL
SECTION-A DEMOGRAPHIC DATA
Notes : Kindly furnish the following details by placing a tick mark in appropriate
choice.
1. Age in years
a. 21 -30 b. 31 -40
c. 41 - 50 d. 51 – 60
2. Gendera. Male b. Female
3. Diet patterna. vegetarian b. non vegetarian
4. Habitsa. Cigarette smoking b. Alcohol
c. Tobacco d. None
5. Body mass indexa. under weight b. normal
c. Over weight d. Obese
6. Ambulationa. Mobilized b. Partially mobilized c. Immobilized
7. Size of the cannulaa. 16G b. 18G
c. 20G d. 22G
8. Frequency of medicationa. od b. bd c. tds d. qid e. continuous
9. Types of drugs administered in affected site
a. Antibiotic b. Anticoagulant
c. inotropes d. Other drugs
10. Types of intravenous fluids administrationa. iv crystalloids b. iv colloids
c. blood
11. History of chronic diseasea. Yes b. No
SECTION – B
MODIFIED VISUAL INFUSION PHLEBITIS SCALE
SNO
CRITERIA 1 2 3 4 OBTAINEDSCORE
1PAIN
Not Experiencing pain
Experiencing pain by touching
Experiencing pain by movement
ExperiencingPain while administeringmedication
2SWELLING Not present
Up to 1cm around the siteof insertion
<2cm in proximal/distalarea
<4cm in proximal/distalarea
3TENDERNESS Not present
Up to 1cm around the siteof insertion
<2cm in proximal/distalarea
<4cm in proximal/distalarea
4 WARMTH Not present Mild Moderate Severe
5 REDNESS Not present Mild Moderate Severe
GRADING
0 - 5 No thrombophlebitis.
6 – 10 Mild thrombophlebitis.
11- 15 Moderate thrombophlebitis.
16 – 20 severe thrombophlebitis.
1
CHAPTER –I
INTRODUCTION
Intravenous therapy is an essential part of clinical care used in wide
variety of healthcare settings and thus intravenous catheters have become
indispensable to clinical practice. Estimates suggest that 80% of all patients
who enter into the health service each year receive Intravenous therapy.
Inserting an intravenous cannula is often a precautionary move aimed at
providing quick and efficient access in an emergency. Maintaining single
indwelling cannula for longer duration is limited by the development of
superficial thrombophlebitis.
Thrombophlebitis is viewed as a natural consequence of routine
intravenous therapy and presents with fever, pain, erythema and cord like
swelling. The incidence of superficial thrombophlebitis is high and usually
occurs within 72 hours of intravenous cannula insertion. It is important for the
clinician to be aware of the potential for injury as a result of medications or
fluid leakage into the tissue and damage to a vein can occur as a consequence
of indwelling catheters, trauma or the infection of the irritating substances. Any
form of injury to a blood vessel can result in thrombophlebitis. In intravenous
thrombophlebitis, the blood clot usually attaches firmly to the wall of the
affected vein.
Strategies to prevent thrombophlebitis need to be developed and it
should reflect on the advances in technology and delivery of health care.
Current guidance recommends a number of strategies to reduce the incidence
of catheter related bloodstream infections. These include applying the principle
of asepsis, the choice of catheter material, the site of insertion and when to
replace the equipment used.
Hot fomentation relaxes muscles and increases their contractility,
increases blood flow, softens exudates, relieves pain, possibly by promoting
2
muscle relaxation, increasing circulation and promoting psychological
relaxation and a feeling of comfort, acts as a counterirritant.
Moist heat fomentation is a topical treatment of pain or inflammation
.This heat causes dilation of the blood vessels and increases the blood supply to
the area, thus stimulating metabolism and the growth of new cells and tissues.
NEED FOR THE STUDY:
A hospital nurse probably spends up two-thirds of her shift on
intravenous related responsibilities like venipunctures or inserting cannulas,
hanging fluids, calculating and administering intravenous medications,
assessing intravenous sites and removing intravenous lines. The frequent use of
intravenous catheters carries with it, many potential risks, both mechanical and
infections. Not all intravenous complications can be avoided but assessment
skills, recognizing their key signs and symptoms, ability to identify problems
can minimize risks for patients and will help to avoid life-threatening
situations.
Various factors have been attributed to the development of
thrombophlebitis which include size of catheter material (steel or venflon,)
length of time the catheter is in a vein, type of solution administered and use of
small vein or veins of the lower extremities where blood flow is relatively
sluggish. It is implicated that all peripheral intravenous catheters should be
changed every 72 hours.
Nurses are in unique position to provide the best care to the post
operative patients with intravenous infusion during their hospitalization. So she
could prepare guidlines for the care of the patients during intravenous infusion
or injection, with the aim of reducing complication related to intravenous
infusion. Using schedule for observation of patients who are on intravenous
3
infusion, the nurse should aim for early recognition the signs and symptoms of
infection and other intravenous complication.
A standardized prospective survey was conducted for nosocomial
infections, to determine the interplay of factors that contribute to the risk of
thrombophlebitis in peripheral non-steel, non-butterfly intravenous catheters.
They studied 3094 patients with 5161 total episodes of peripheral intravenous
cannulation from the day of admission until the day of discharge. The results
showed that the overall rate of phlebitis was 2.3% and the rate of intravenous
catheter-associated bacteremia was 0.08%. In all other circumstances, 48-72
hours was recommended.
A priority care for patient with IV therapy is to prevent, asses, and detect
these complications. In some cases nurses lead to manage these
problems.Having a specialized team of infusion nurses to initiate and maintain
infusion therapy is recommended by the center for disease control and
prevention (CDC) to reduce complications of infusion therapy.
The infusion nurses society (INS) publishes guidelines and tools for to
identify early signs of complications. The current standard medical therapy for
thrombophlebitis is topical heparin application for 7 days from day 1 of
intravenous cannula insertion. Interventions for thrombophlebitis include
thrombophob ointment, Icthomal and glycerin paste application and cold
application. The researcher is interested to evaluate the effectiveness of hot
fomentation on thrombophlebitis.
4
STATEMENT OF THE PROBLEM
A study to assess the effectiveness of hot fomentation on
thrombophlebitis among patients received intravenous therapy at selected
hospitals Tittagudi.
OBJECTIVES OF THE STUDY
1. To assess the level of thrombophlebitis among patients received
intravenous therapy.
2. To assess the effectiveness of hot fomentation on thrombophlebitis
among patients received intravenous therapy.
3. To associate the post test level of thrombophlebitis after hot fomentation
among patients received intravenous therapy with their selected
demographic variables.
RESEARCH HYPOTHESES
• H1: There is a significant reduction in thrombophlebitis among patients
received intravenous therapy after hot fomentation.
• H2: There is a significant association between the post test level of
thrombophlebitis with hot fomentation among patients received
intravenous therapy and their selected demographic variables.
OPERATIONAL DEFINITIONS
• Effectiveness: It refers to determining the extent to which the local
moist heat application relieves the signs and symptoms of
thrombophlebitis as measured by visual infusion phlebitis scale.
• Hot fomentation: A local moist heat application over the site of
thrombophlebitis using lint cloth dipped in hot water at a temperature of
105°F – 115°F / 40°C – 45°C, applied for 15 minutes two times a day
for three days.
5
• Thrombophlebitis: It refers to inflammation of lining of the vein after
intravenous cannulation and continuous exposure to intravenous fluid
and medication, characterized by pain, cord like swelling, warmth and
tenderness, redness along the course of the vein.
• Patient: It refers to the individual who is admitted in the hospital with
medical or surgical condition developed thrombophlebitis after
intravenous therapy.
• Intravenous therapy: it is the treatment by intravenous fluids and
medications that the patient is receiving, like intravenous- crystalloids,
intravenous– colloids.
ASSUMPTIONS
• Intravenous cannulation and administration of drugs or fluids causes
thrombophlebitis.
• Thrombophlebitis produces discomfort at the site of intravenous
cannulation.
• Application of hot fomentation may reduce the signs and symptoms
caused by thrombophlebitis.
DELIMITATIONS
The study is delimited to
• Patients who are admitted in Medical/Surgical wards only during the
study period.
• The sample size of the study is limited to 60.
• Patients between the ages of 21-60 years.
• The setting is limited to only two hospitals
PROJECTED OUTCOME
The findings of the study will help the nurses to implement hot
application to reduce the discomfort of patient with thrombophlebitis.
6
CHAPTER II
PART I
REVIEW OF LITERATURE
A review of literature can help to clarify a problem, justify research for
the proposed problem, throw light on appropriate methodology and contribute
towards the development of a conceptual framework. The investigator has
discussed the literature review in the following sections:
Section a: review of literature related to thrombophlebitis in general
Section b: review of literature related to prevention of thrombophlebitis
Section c: review of literature related to application of hot fomentation in
reducing thrombophlebitis
Section a: review of literature related to thrombophlebitis in general
Parker lynn. (2002) reviewed studies on the clinical importance,
diagnosis, incidence and pathogenesis of peripheral vein infusion
thrombophlebitis including catheter-related and patient-related risk factors.
They concluded that peripheral vein infusion thrombophlebitis occurred in 25-
35% of hospitalized patients with peripheral intravenous cannulation and it had
both patient-related e.g. Sepsis and economic consequences e.g. Extra nursing
time, duration of catheterization and catheter-related infection.
Tagalakis V.et.al (2002) did a randomized controlled study in which a
standard nutritional solution was infused via 22 gauge polyurethane catheters
inserted to a length of either 5cms or 15cms. Catheters were observed twice
each day and removed when complications occurred or when intravenous
nutrition (IVn) was no longer required. The study indicated that catheters
inserted into cephalic veins were more prone to thrombophlebitis than catheters
inserted into the basilic veins. They concluded that the risk of thrombophlebitis
7
was not influenced by the length of the catheter within the vein. However, the
vein in which the catheter tip lay appeared to influence the development of
thrombophlebitis.
Parker lynn(1999) assessed the possibility that delivery system rather
than the intravenous nutrition (IVn) is the main influence of thrombophlebitis.
This was examined in a randomized comparison of a fine- bore silicone
catheter against a short teflon cannula. Thrombophlebitis developed in all
patients in the teflon group but only 7% in the silicone group. The results
showed that when a nutrient solution is delivered through a peripheral vein
with an ultrafine-bore silicone catheter, the risk of thrombophlebitis is low.
Lanbeck p et.al (2004) reviewed 23 literature references to identify the
optimal time for the routine replacement of intravenous administration sets
when the infusate or parenteral nutrition (lipid and non-lipid) solutions or
infusions (excluding blood and blood products) were administered to people in
hospital via central or peripheral venous catheters. They concluded that IV
administration set that does not contain lipids, blood or blood products may be
left in place for intervals of up to 96 hours without increasing the incidence of
infection.
Barnuambarbaras (1998) assessed the occurrence of thrombophlebitis
in a coronary care unit in relation to the use of short plastic intravenous
cannula. The incidence of thrombophlebitis was 51% in cases where cannula
was used for continuous infusion of 5% glucose and 13% for cannula which
were locked after the injection of heparin. Cases of thrombophlebitis had a
chemical or mechanical etiology. Replacement of 5% glucose by 0.9% sodium
chloride solution for continuous infusion reduced the incidence of
thrombophlebitis to 33%. They concluded that heparin-locked cannula is a safe
alternative to continuous infusion.
8
Trehan N.et al (2007) conducted a review to determine the relationship
between peripheral IV catheter indwell time and phlebitis in hospitalized
adults. A retrospective review of quarterly quality assurance data monitoring
indwell time, phlebitis rating, and site and tubing labels was performed. Of
1,161 sites, only 679 had documented indwell time. Average indwell time was
1.9 days, and overall phlebitis rate was 3.7%. Analyses of variance revealed a
significant association between phlebitis and indwell time.
Section b: literature related to prevention of thrombophlebitis
Tagalakis v.(2002) a clinical audit conducted in peripheral intravenous
cannulation using the standards of infusion therapy. The findings of the audit
highlighted several areas for improvement in peripheral intravenous
cannulation care. They found that the most significant finding was poor
documentation of the insertion of the cannula. An additional concern was that
the person who performed the cannulation could not be identified in 37.7% of
peripheral venous cannula audited.
Everitt NJ(1997) conducted to assess whether IV care conformed to the
hospital policy. The study was done on 131 patients with 155 peripheral IV
lines in Stluke’s hospital, Pennsylvania. The peripheral line assessment
revealed those 87 sites (56%) < 72 hours old, 4 sites (3%) > 72 hours old and
64 sites (41%) that were not recorded. The researcher suggested need for
improvements which included the need to date all dressings/ infusion tubing,
proper labeling of all bottled/bags and efforts to ensure that patients wear an
identification bracelet.
Section c: review of literature related to application of hot fomentation in
reducing thrombophlebitis
Purungala AA (2009)a quasi experimental study was conducted on “the
effectiveness of hot fomentation in reducing the signs and symptoms of
thrombophlebitis caused by intravenous infusion and medications” among in-
9
patients in Medical or Surgical wards at RMMCH, Chidambaram, Tamilnadu.
A sample of 30 patients with IV thrombophlebitis (15 in experimental and 15
in control groups) were selected. Experimental group was provided with the
moist hot fomentation for 15 mts every 2 hrs up to a total of 8 hours (105-115o
F / 40-460C). Data collection was done using interview and observational
method. The average pain level in the experimental group was 2.86 initially. At
the end of the intervention, the pain reduced from 2.86 to no pain in the
experimental group. This showed the effectiveness of hot fomentation. To
assess these variations, two way ANOVA repeated measures analysis was done
{p<0.001}. The average level of swelling in the experimental group was 1.90
initially. At the end of the intervention, the swelling was reduced from 1.90 to
no swelling (0.00) in the experimental group. This also showed the
effectiveness of hot fomentation.
Anjum S (2007) a quasi-experimental study was conducted on “the
effectiveness of hot fomentation v/s cold compress for reducing intravenous
infiltration” in a selected hospital in Pune city. Pre-test and post-tests were
conducted in a sample of 60.Data collection tools included an observational
check list which consisted of standardized infiltration scale and behavioral pain
scale. Findings proved that the pre treatment mean score of degree of
infiltration was 7.1667 and it was decreased to 0.7071 on the 3rd day of
treatment with hot fomentation. The pre-treatment mean score of degree of
infiltration was reduced from 6.9333 to 0.7571 on the third day of treatment
with cold compress treatment. The intensity of pain was reduced from severe
(56.66%) to no pain (93.4%) in hot fomentation group. In cold compress group,
the intensity of pain was reduced from moderate(60%) to no pain(86.6%).The
mean score of hot fomentation group was 6.5067 in reducing the degree of
infiltration while cold compress the mean score was 6.6.It proved that the hot
fomentation is better than the cold compress.
Fink, et al (2009) determined the impact of dry versus moist heat on
peripheral IV catheter insertion site. A two group randomized controlled
10
clinical design was adopted in an academic cancer infusion center. Seven
minutes prior to cannulation the patients were randomly assigned to dry or
moist heat with warmed towels wrapped around the arm. Number of IV
insertion attempts patients anxiety levels pre and post heating and patient
comfort were measured by using the visual analog scale. The results of the
study was that the IV insertion rates were more difficult in participate who
had moist heat applied (mean=4,sd=2.8) then in participates who had dry heat
(mean=3.1,sd=2.4,+=2.01,p=0,046) considering vein status,dry heat was 2.7
times more likely to result in successful IV insertion . The conclusion of the
study was that dry heat application decreases multiple insertion attempts, and
its comfortable safe and economical.
Beer (2002) carried out a study to determine whether local warming of
the hand help in inserting cannulas. The patients were asked to immerse their
hands in warm water. But they were not always successful because when the
patients had return to their chair and dried their hands, the benefit of local
warming was reduced. This lead them to investigator other forms of local
warming methods which proprietary wheat filled bags. Each bag measures
approximately 150cmx 50cm and is heated in microwave on high for 2minutes.
This method also reduced the number of attempt at cannulation.
Kober, et al (2003) did a study on local warming: an effective
treatment for pain and anxiety during intravenous cannulation. The purpose of
the study was to show that local warming reduces pain and anxiety during
intravenous cannulation. The total samples were 100 and they randomly
assigned to active warming group and no warming group. The total study was
assessed with visual analog scale. Statistical evaluation was perform using the
“t’ test with p<0.05 which is considered significant. The results of the study
was that in group 1 the anxiety significantly decreased before and treatment
(p<0.01) and in group 2 a non- significant changes were noted. The conclusion
of the local active warming is an effective and easy way to reduce pain and
anxiety of the patients during intravenous cannulation.
11
PART II
CONCEPTUAL FRAME WORK
The conceptual frame work for the study was based on general system
theory developed by ludwig von Bertalanffy’s in 1968. This system theory
explains dividing the whole thing in two parts and working together of these
parts in system. According to this model, a system set of objects which are
related between themselves and their attributes. The object contributing to the
system behaves together as a whole. Changes in any part will affect whole
system. All living system or open systems which means that they exchange
energy matter and information across their boundaries with the environment
general system theory consist of scientific explanation whole or wholeness; it
has its sub system. The main concepts of sub system are input, through put,
output. Input and output are the process by which a system is able to
communicate and react with its environment.
Input
Refers to matter, energy and information enters in to the system its
boundary. In this study, input consists of demographic variable of age, sex,
body built, frequency of intravenous medication, type of ambulation and
existing status of thrombophlebitis measured by modified visual infusion
phlebitis scale by observation check list.
Through put
Is a process that occurs some point between the input and output
process. It enables the input to be transformed in such a way that it can be
readily by the system. In this study through put was considered as intervention
of hot fomentation for 15 minutes morning and evening for three days over
thrombophlebitis site.
12
Output
Is an energy, information (or) matter that is transformed to the
environment. Change in thrombophlebitis signs and symptoms of pain, cord
like swelling, tenderness, warmth, and redness after hot fomentation. This
output was evaluated by the post test after treatment. This is ultimately
resulting in the improvement of quality of care.
13
THE EFFECT OF HOT FOMENTATION ON THROMBOPHLEBITIS AMONG PATIENTS RECEIVEDINTRAVENOUS THERAPY
INPUT THROUGHPUT OUTPUT
Application of Hotfomentation at
temperature of 105f-115f/ 40c-45c applied for 15
minutes morning andevening 3 days over site
of thrombophlebitis.
Change in the level ofthrombophlebitis
Background Factors• Age• Sex• Diet• Habit• Body mass
index
FEED BACK
Existing status of thrombophlebitis
• Pain• Swelling• Tenderness• Warmth• redness
IV infusion factors• Size of
cannula• Type of IV
fluid medicationF f
No thrombophlebitis
Moderatethrombophlebitis
Severethrombophlebitis
REINSTITUTION
Mild thrombophlebitis
Figure 1.CONCEPTUTAL FRAME WORK BASED ON (LUDWIG VON BERTALANFFY’S (1968) GENERALSYSTEM THEARY
14
CHAPTER-III
RESEARCH METHODOLOGY
This chapter describes the methodology followed to assess the
effectiveness of hot fomentation on the thrombophlebitis among patients
received intravenous therapy at selected hospitals. It includes research design,
variables, settings, population, and sample, criteria for sample selection, sample
size, sampling technique, development and description of tool, content validity,
pilot study, data collection procedure and plan for data analysis.
RESEARCH APPROACH
Quantitative Evaluative approach.
RESEARCH DESIGN
True experimental pretest –post test control group design.
R
Groups Pre-test Intervention Post-test
Experimental Group O1 x O2
Control group O1 - O2
R –Randomization.
O1–Pre-test assessment of thrombophlebitis.
X – Hot fomentation on thrombophlebitis.
O2 – Pos-test assessment of thrombophlebitis.
15
VARIABLES
Dependent variable: Thrombophlebitis.
Independent variable: Hot fomentation.
SETTING OF THE STUDY
The study was conducted in Medical/Surgical wards in Government &
private hospitals (Sai dhanvanthiri hospital) Tittagudi.
POPULATION
Inpatients with thrombophlebitis received intravenous therapy in
medical/surgical wards at government and private hospitalsTittagudi.
SAMPLE
Inpatients who have developed thrombophlebitis after intravenous
infusion and medications administration.
SAMPLING TECHNIQUE
Simple random sampling technique.
SAMPLE SIZE
60 patients (30 in experimental group and 30 in control group)
DURATION OF THE STUDY
4 Weeks
16
CRITERIA FOR SAMPLE SELECTION
a. Inclusion criteria
1. Patients who have developed thrombophlebitis due to intravenous
infusion and medications.
2. Patients admitted in Medical and Surgical wards.
3. Adult patients between (21 to 60 years).
4. Patients who are willing to participate.
b. Exclusion criteria
1. Adults less then 21 years and above 60 years.
2. Patients receiving cancer chemotherapy drugs, oral contraceptive pills
and steroids.
3. Patients who are not willing to participate in this study.
4. Patients attending outpatient department.
DEVELOPMENT AND DESCRIPTIVE OF DATA COLLECTION
TOOL
The investigator used a modified visual infusion phlebitis scale to assess
the thrombophlebitis.
STRUCTURED QUESTIONNAIRE
The structured questionnaire was developed
Section I: Comprises of questions to elicit demographic data.
Section II: Modified visual infusion phlebitis scale. It consist5 components of
pain, swelling,tenderness, warmth and redness, each divided into
1-4 scores.
17
SCORING AND GRADING PROCEDURE
SCORING - The observed condition of thrombophlebitis is given score
as per description given in the scale. The score obtained by observation is
graded as follows:
GRADING PROCEDURE
5 : No Thrombophlebitis
6-10 : Mild thrombophlebitis
11-15 : Moderate thrombophlebitis
16-20 : Severe thrombophlebitis
CONTENT VALIDITY
For content validity the research experts were requested to give their
opinion about the content areas and its relevance and appropriateness of the
items. Content validity obtained from five experts in the department of medical
and surgical nursing. Items were modified based on their suggestions.
RELIABILITY
The researcher has adapted the standardized visual infusion phlebitis
scale with only one modification of one section of pain component and used as
modified visual infusion phlebitis scale. The reliability was not assessed as it
was already established.
PILOT STUDY
The pilot study was done at government and private hospitals from
19.05.14 to 26.05.14 to test the feasibility, relevance and practicability.
Permission was sought from the Managing Director Sai dhanvanthiri hospital,
Tittagudi and the Medical Superintendent of Government hospital, Tittagudi.
18
The consent was obtained from all the samples after explaining the purpose of
the study, then role and their doubts were clarified. The pilot study was
conducted among 6 patients, 3 in experimental group and 3 in control group,
selected by simple random sampling technique. The intervention of hot
fomentation over the site of thrombophlebitis for 15 minutes, morning and
evening 2 times a day for 3 days was done. Post test done with the same scale
on the fourth day. The data analysis showed that the study was found to be
feasible and it was decided to continue main study without any modifications.
COLLECTION OF DATA
Data Collection was done from 04.06.14 to 04.07.14 at government and
private hospitals, Tittagudi. Patients who received IV therapy were screened
for thrombophlebitis and the sample were recruited by simple random sampling
technique in the medical and surgical wards. The purpose of the study was
explained, written consent was obtained from all patients before the study.
Demographic data collected and the thrombophlebitis was assessed with visual
infusion phlebitis scale as pre test on the first day. Hot fomentation intervention
over the site of thrombophlebitis for 15 minutes, morning and evening 2 times
a day for 3 days was done. Post test was done with the same scale on the fourth
day. The researcher herself collected the data by using the observation method
with help of observation check list.
PLAN FOR DATA ANALYSIS
It was planned to analyse the collected data by using descriptive and
inferential statistics.
19
DESCRIPTIVE STATISTICS
1. Frequency and percentage distribution will be used to analyze the
demographic variable and level of thrombophlebitis among hospitalized
patients.
2. Mean and Standard deviation to describe the thrombophlebitis.
INFERENTIAL STATISTICS
1. The paired’t’ test will be used to assess the effectiveness with group
and independent‘t’ test will be used to assess the effectiveness of hot
fomentation.
2. Chi square test will be used to find the association of post test scores
with their selected demographic variables.
ETHICAL CONSIDERATION
• The study was performed after getting approval from the
dissertation Ethical of committee, THANTHAI ROEVER
COLLEGE OF NURSING.
• Permission was obtained from the managing director of
Saidhanvanthiri hospital and medical superintendent of
government hospital, Tittagudi.
• The written consent was obtained from each study participant
before collecting the data.
• Confidentiality was maintained throughout the study.
20
TARGET POPULATIONMEDICAL & SURGICAL WARD PATIENT
ACCESSIBLE POPULATIONMEDICAL/SURGICAL WARD PATIENT WITHTHROMBOPHLEBITIS TITTAGUDI PRIVATE
HOSPITAL
SAMPLINGSIMPLE RANDOM
SAMPLING TECHNIQUE
EXPREMENTAL GROUP 30
PRE TEST
INTERVENTION HOTFOMENTATION
POST TEST
DATA COLLECTIONINTERVIEW CUM OBSERVATIONAL
WITH MODIFIED VISUAL INCLUSION
DESCRIPTIVE AND INFRENTIAL STATISTS
FINDINGS
REPORT
CONTROL GROUP
PRE TEST
NO INTERVENTION
POST TEST
SCHEMATIC REPRESENTATION OF RESEARCHMETHODOLOGY
21
CHAPTER – IV
DATA ANALYSIS AND INTERPRETATION
The analysis is a process of organizing and synthesizing the data in such
a way that the research question can be answered and hypothesis tested (Polit
and Hungler, 2011).
This chapter deals with analysis and interpretation of the data collected
from 60 patients received intravenous therapy. The data was organized,
tabulated and analyzed according to the objectives. The findings are presented
under the following sections.
ORGANIZATION OF THE DATA
SECTION I: Description of the demographic variables of the patients
with thrombophlebitis received intravenous therapy in
experimental and control group.
SECTION II: Pre and post test level of thrombophlebitis among patients
received intravenous therapy in experimental and control
group.
SECTION III: Comparison of pre and post test mean score of
Thrombophlebitis among patients received
Intravenous therapy in experimental group and
control group.
SECTION IV: Association of post test level of thrombophlebitis among
patients received intravenous therapy with their selected
demographic variables in the experimental group.
22
SECTION- I
Table 1: Frequency and percentage distribution of demographic
variables of the patients with thrombophlebitis received
intravenous therapy in experimental and control group.
N = 60(30+30)
Demographic Variables Experimental Group Control GroupF % F %
Age in years 21 – 30
31 – 40
41 – 50
51 – 60
9
12
9
0
30.00
40.00
30.00
0.00
16
4
8
2
53.33
13.33
26.676.67
Gender
Male
Female
12
18
40.00
60.00
16
14
53.33
46.67Diet pattern
Vegetarian
Non-vegetarian
5
25
16.67
83.33
5
25
16.67
83.33Habits
Cigarette smoking
Alcohol
Tobacco
None
2
7
4
17
6.67
23.33
13.33
56.67
6
5
2
17
20.00
16.67
6.67
56.67Body Mass Index
Underweight
Normal
Overweight
Obese
2
25
3
0
6.67
83.33
10.00
0.00
9
15
6
0
30.00
50.00
20.00
0.00Ambulation Mobilized 29 96.67 29 96.67Partially mobilized 1 3.33 1 3.33Immobilized 0 0.00 0 0.00
23
Demographic Variables Experimental Group Control GroupF % F %
Size of cannula 16 G 0 0.00 0 0.0018 G 11 36.67 7 23.3320 G 16 53.33 23 76.6722 G 3 10.00 0 0.00Frequency of medication Od 10 33.33 9 30.00Bd 20 66.67 21 70.00Tds 0 0.00 0 0.00Qid 0 0.00 0 0.00Continuous 0 0.00 0 0.00Type of drugs Antibiotic 16 53.33 19 63.33Anticoagulant 1 3.33 0 0.00Inotropes 0 0.00 0 0.00Other drugs 13 43.33 11 36.67Types of intravenous fluids IV crystalloids 29 96.67 27 90.00IV colloids 1 3.33 3 10.00Blood 0 0.00 0 0.00History of chronic disease Yes 3 10.00 7 23.33No 27 90.00 23 76.67
The table 1 depicts that in experimental group majority 12(40%) of
patients were in the age group of 31 – 40 years, and equal representation
of 9(30%) to groups of 21-30 and 41-50 years. The Majority 18(60%)
were female, and 12(40%) were male. The Majority 25(83.33%) were
non-vegetarian, and 5(16.67%) were vegetarian. The Majority
17(56.67%) had no bad habits, 7(23.33%) were alcoholic, 4(13.33%)
were of tobacco users, 2(6.66%) were smokers. The Majority of patients
25(83.33%) had Normal BMI, 3(10%) had overweight, 2(6.66%) had
underweight. The majority of patients 29(96.67%) had been mobilized
ambulated. Majority of patients 16(53.33%) were cannulated with 20G
size of cannula, 11(36.67%) had 18G size of cannula, and 3(10%) had
22G size of cannula. The Majority of patients 20(66.67%) received bd
24
medication and 10(33.33%) received od medication. The Majority of
patients 16(53.33%) received antibiotic, 13(43.33%) received other
drugs. the majority of patients 29(96.67%) were administered with IV
crystalloids. The Majority of patients 27(90%) had no history of chronic
disease, and 3(10%) had the chronic disease.
In control group majority 16(53.33%) of patients were in the age
group of 21 – 30 years, next majority 8(26.67%) in the age group of 41-
50years, the least number of age group 2(6.67) 51-60 years. The equalent
gender representation with 16(53.33%) male, and 14(46.67%) female.
The Majority 25(83.33%) were non-vegetarian,5(16.67%) were
vegetarian. The Majority 17(56.67%) had no bad habits, and 6(20.00%)
were cigarette smokers, 5(16.67%) were alcoholic, 2(6.67%) were
tobacco users. The Majority of patients 15(50%) had Normal BMI,
9(30%) were underweight, and 6(20%) were overweight. The Majority of
patients 29(96.67%) had been mobilized ambulated and 1(3.33%) is
partially mobilized ambulated. The Majority of patients 23(76.67%) were
cannulated with 20G size cannula, 7(23.33) had 18G size of cannula. the
majority of patients 21(70.%) received bd medication, 9(30%) received
od medication. The Majority of patients 19(63.33%) received antibiotic,
11(36.67) received other drugs. The Majority of patients 27(90.00%)
received crystalloids and 3(10%) were colloids. The Majority of patients
23(76.66%) had no history of chronic disease, and 7(23.33%) had the
chronic disease.
29
SECTION II
Table 2a: Frequency and percentage distribution of pre and post
test level of thrombophlebitis among patients received
intravenous therapy in experimental group.
n=30
Level of
thrombophlebiti
s
Pre test Post test
F % F %
No 0 0 13 43.33
Mild 0 0 17 56.67
Moderate 23 76.67 0 0
Severe 7 23.33 00
The table 2 shows that in pretest majority of the patients in the
experimental group 23(76.67%) had moderate level of thrombophlebitis,
7(23.33%) had severe level of thrombophlebitis.
In the post test, majority 17(56.67%) had mild level of thrombophlebitis,
13(43.33%) had no thrombophlebitis.
30
Figure 3.1 Percentage distribution of pre and post test level of thrombophlebitis among patients received
intravenous therapy in experimental group
32
Table 2b: Frequency and percentage distribution of pre and post
test level of thrombophlebitis among patients received
intravenous therapy in control group.
n = 30
Level of
Thrombophlebitis
Pre test Post test
F % F %
No 0 0 0 0
Mild 1 3.33 26 86.67
Moderate 25 83.33 4 13.13
Severe 4 13.33 00
The table 3 shows that in pretest majority of the patients in the control
group 25(83.33%) had moderate level of thrombophlebitis, 4(13.33%) had
severe level of thrombophlebitis, 1(3.33%) had mild level of thrombophlebitis.
In post test, majority 26(86.67%) had mild level of thrombophlebitis,
4(13.13%) had moderate level of thrombophlebitis.
34
SECTION III
Table 3a: Comparison of pre and post test mean score of
thrombophlebitis among patients received intravenous
therapy in experimental group.
n = 30
Experimental
Group
Max
Scor
e
Mean S.DMean
Diff.Paired ‘t’ Value
Pretest 20 13.90 1.888.10
t = 24.551***
p = 0.000, SPost Test 20 5.80 0.85
***p<0.001, S – Significant
The table 3a shows that the pretest mean score of thrombophlebitis in
experimental group was 13.90 with S.D 1.88 and the post test mean score was
5.80 with S.D 0.85. The mean difference was 8.10 and the calculated paired‘t’
value of t = 24.551 was found to be statistically significant at p<0.001 level.
35
Figure 4.1 Comparison of pre and post test mean score of thrombophlebitis among patients received
intravenous therapy in experimental group
37
Table 3b: Comparison of pre and post test mean score of
thrombophlebitis among patients received intravenous
therapy in control group.
n = 30
Control Group M
SMean S.D Mean Diff. Paired ‘t’ Value
Pretest 20 13.73 1.624.36
t = 15.509***
p = 0.000, SPost Test 20 9.37
1.52
***p<0.001, S – Significant
The table 3b shows that the pretest mean score of thrombophlebitis in
control group was 13.73 with S.D 1.62 and the post test mean score was 9.37
with S.D 1.52. The mean difference was 4.36 and the calculated paired ‘t’
value of t = 15.509 was found to be statistically significant at p<0.001 level.
38
Figure 4.2 Comparison of pre and post test mean score of thrombophlebitis among patients received
intravenous therapy in control group
40
Table 3c: Comparison of post test mean score of thrombophlebitis
among patients received intravenous therapy between
the experimental and control group.
N = 60(30+30)
Group Mean S.D Mean Diff.Unpaired ‘t’
Value
Experimental Group 5.80 0.853.57
t = 11.229***
p = 0.000, SControl Group 9.37 1.52
*p<0.05, S – Significant
The table 3c shows that the post test mean score of thrombophlebitis in
experimental group was 5.80 with S.D 0.85 whereas in the control group the
post test means score was 9.37 with S.D 1.52. The mean difference was 3.57
and the calculated unpaired‘t’ value of t = 11.229 was found to statistically
significant at p<0.05 level.
42
SECTION IV
Table 4a: Association of post test level of thrombophlebitis among
patients received intravenous therapy with their selected
demographic variables in the experimental group.
n = 30
Demographic VariablesNo Mild Chi-Square
ValueNo. % No. %
Age in yearsχ2 = 0.928
d.f = 2
p = 0.629
N.S
21 – 30 5 16.7 4 13.3
31 – 40 5 16.7 7 23.3
41 – 50 3 10.0 6 20.0
51 – 60 - - - -
Genderχ2 = 0.362
d.f = 1
p = 0.547
N.S
Male 6 20.0 6 20.0
Female 7 23.3 11 36.7
Diet patternχ2 = 0.027
d.f = 1
p = 0.869
N.S
Vegetarian 2 6.7 3 10.0
Non-vegetarian 11 36.7 14 46.7
Habitsχ2 = 0.141
d.f = 3
p = 0.986
N.S
Cigarette smoking 1 3.3 1 3.3
Alcohol 3 10.0 4 13.3
Tobacco2 6.7 2 6.7
None 7 23.3 10 33.3Body Mass Index χ2 = 7.846
43
Demographic VariablesNo Mild Chi-Square
ValueNo. % No. %
d.f = 2p = 0.029
S*
Underweight 2 6.7 0 0
Normal 8 26.7 17 56.7
Overweight 3 10.0 0 0
Obese - - - -
Ambulation χ2 = 0.791
d.f = 1
p = 0.374
N.S
Mobilized 13 43.3 16 53.3
Partially mobilized 0 0 1 3.3
Immobilized - - - -
Size of cannulaχ2 = 0.907
d.f = 2
p = 0.635
N.S
16 G - - - -
18 G 5 16.7 6 20.0
20 G 6 20.0 10 33.3
22 G 2 6.7 1 3.3
Frequency of medication
χ2 = 3.326
d.f = 1
p = 0.068
N.S
Od 2 6.7 8 26.7
Bd 11 36.7 9 30.0
Tds - - - -
Qid - - - -
Continuous - - - -
Type of drugs χ2 = 1.434
d.f = 2
p = 0.488
N.S
Antibiotic 7 23.3 9 30.0
Anticoagulant 1 3.3 0 0
Inotropes - - - -Other drugs 5 16.7 8 26.7
Types of intravenous fluids χ2 = 1.353
d.f = 1IV crystalloids 12 40.0 17 56.7
44
Demographic VariablesNo Mild Chi-Square
ValueNo. % No. %
p = 0.245
N.S
IV colloids 1 3.3 0 0
Blood - - - -
History of chronic diseaseχ2 = 4.359
d.f = 1
p = 0.037
S*
Yes 3 10.0 0 0
No 10 33.3 17 56.7
*p<0.05, S – Significant, N.S – Not Significant
The table 4a shows that the demographic variables body mass index and
history of chronic disease have shown statistically significant association with
the post test level of thrombophlebitis among patients received intravenous
therapy at p<0.05 level in the experimental group. The other demographic
variables had not shown statistically significant association with the post test
level of thrombophlebitis among patients received intravenous therapy.
45
CHAPTER V
DISCUSSION
The main aim of the study was to assess the effectiveness of hot
fomentation on thrombophlebitis among patient received IV therapy at
Government and Private Hospitals, Tittagudi. The research design adopted for
this study was pre test and post test control group design. The setting of the
study was Government and Private Hospitals, Tittagudi. The sample size
consists of 60 sample in which 30 sample were in the Experimental group [hot
fomentation] and 30 in the control group.
The First objective of the study was to assess the level of
thrombophlebitis among patients received IV therapy.
In pretest the majority of the patients in the experimental group
23(76.67%) had moderate level of thrombophlebitis whereas in the post test,
majority 17(56.67%) had mild level of thrombophlebitis 13% had no
thrombophlebitis.
In pretest the majority 25(83.33%) had moderate level of
thrombophlebitis whereas in the post test, majority 26(86.67%) had mild level
of thrombophlebitis among patients in the control group.
The second objective of the study was to assess the effectiveness of
hot fomentation on the thrombophlebitis among patient received IV
therapy.
The pretest mean score of thrombophlebitis of experimental group was
13.90 with S.D 1.88 and the post test mean score was 5.80 with S.D 0.85. The
mean difference score was 8.10 and the calculated paired‘t’ value of t = 24.551
was found to be statistically significant at p<0.001 level.
46
The pretest mean score of thrombophlebitis in control group was 13.73
with S.D 1.62 and the post test mean score was 9.37 with S.D 1.52. The mean
difference was 4.36 and the calculated paired ‘t’ value of t = 15.509 was found
to be statistically significant at p<0.001 level.
The post test mean score of thrombophlebitis in experimental group was
5.80 with S.D 0.85 whereas in the control group the post test means score was
9.37 with S.D 1.52. The mean difference was 3.57 and the calculated
unpaired‘t’ value of t = 11.229 was found to be statistically significant at
p<0.001 level.
Based on the study findings the stated hypothesis H1 there is a
significant reduction in thrombophlebitis after hot fomentation among
patient received intravenous therapy was accepted.
The third objectives to associate the post test level of
thrombophlebitis among patient received IV therapy with their selected
demographic variables.
The demographic variables body mass index and history of chronic
disease had shown statistically significant association with the post test level of
thrombophlebitis among patients received intravenous therapy at p<0.05 level
in the experimental group.
There was no significant association found between variables of age,
gender, diet, habits, ambulation, size of cannula, frequency of medication,
types of drugs, types of intravenous fluids and the post test level of
thrombophlebitis.
Hence the stated hypothesis H2 There is a significant association
between the post test level of thrombophlebitis and selected demographic
variables among patients received intravenous therapy was not accepted.
47
CHAPTER VI
SUMMARY, MAJOR FINDINGS, IMPLICATIONS,
RECOMENDATION AND CONCLUSION
This chapter was divided into two sections In the first section. summary
of the study, findings and conclusions were presented. In the second section,
the implication in various areas of nursing practice, nursing education, nursing
administration, nursing research, limitation and recommendation for further
study were presented.
SUMMARY OF THE STUDY
The main objective of the study was to assess the effectiveness of hot
fomentation on the thrombophlebitis among patients received intravenous
therapy in government and private hospital Tittagudi.
A Quantitative Evaluative approach, True experimental pre test- posttest
control group design were adopted for this study. Simple random sampling
technique was used to select the sample and the sample size was 60.
Conceptual frame work-ludwig von Bertalanffy’s general system model was
used for this study.
The tool selected for the present study included structure questionnaire
for demographic variables, modified visual infusion phlebitis scale to assess the
thrombophlebitis among patient received intravenous therapy.
The intervention of moist heat fomentation over the site of
thrombophlebitis for 15 minutes, morning and evening 2 times a day for 3 days
was done. Post test was done with the same scale on fourth day. The researcher
herself collected the data by using the observation visual infusion phlebitis
scale.
48
The collected data were analyzed by the descriptive and inferential
statistics, interpreted in terms of objectives and hypotheses of the study. The
study revealed the hot fomentation is found effective reduction of the
thrombophlebitis among patient received intravenous therapy.
I MAJOR FINDINGS OF THE STUDY
• Majority (40%) of the patients in experimental group belongs to 31-40
years and ( 53.33% )in control group belongs to age group of 21 – 30
years.
• Majority (60%) of the patients were female in experimental group and
(53%) were male in control group.
• Majority (83.33%) of patients were non-vegetarian in both the groups.
• Majority (56.67%) of patients had no bad habits in both groups.
• Majority (83.33) of patients in experimental group and (50%) in control
group had normal BMI.
• Majority (96.67%) of patients had been mobilized ambulated in both
groups.
• Majority (53.33%) of the patients in experimental group and (76.67%)
in control group were cannulated with 20G cannula.
• Majority (66.67%) of the patients in experimental group and (70%) in
control group received bd medication.
• Majority (53.33%) of the patients in experimental group and (66.33%)
in control group were administered antibiotic.
49
• Majority (96.67%) of the patients in experimental group and (90%) in
control group were us on intravenous crystalloids infusion.
• Majority (90%) of the patients in experimental group and (76.66%) in
control group had no history of chronic disease.
II FINDINGS RELATED TO STUDY INTERVENTION
1. In the pretest, majority of the patients in the experimental group 76.67%
had moderate level of thrombophlebitis whereas in the post test,
majority 56.67% had mild level of thrombophlebitis among patients in
the experimental group with 13% no thrombophlebitis.
2. In the pretest, majority of the patients in the control group 83.33% had
moderate level of thrombophlebitis whereas in the post test, majority
86.67% had mild level of thrombophlebitis among patients in the
control group.
3. In the pretest, mean score of thrombophlebitis in experimental group
was 13.90 with S.D 1.88 and the post test mean score was 5.80 with
S.D 0.85. The mean difference score was 8.10 and the calculated
paired‘t’ value of t= 24.551 was found to be statistically significant at
p<0.001 level.
4. In the pretest, mean score of thrombophlebitis in control group was
13.73 with S.D 1.62 and the post test mean score was 9.37 with S.D
1.52. The mean difference score was 4.36 and the calculated paired ‘t’
value of t = 15.509 was found to be statistically significant at p<0.001
level.
50
5. The demographic variables body mass index and history of chronic
disease had shown statistically significant association with the post test
level of thrombophlebitis among patients received intravenous therapy
at p<0.05 level in the experimental group.
51
IMPLICATIONS
The findings of the study have implication in various areas of nursing
practice, nursing education, nursing administration and nursing research.
IMPLICATION FOR NURSING PRACTICE
The practice nurse uses the hot fomentation for thrombophlebitis to
reduce it.
The nurse should contribute to the evidence based practice through the
experience gained from hot fomentation to reduction in the
thrombophlebitis.
IMPLICATIONS FOR NURSING EDUCATION
The nurse educator should be oriented, guided and trained in hot
fomentation on thrombophlebitis among patients received intravenous
therapy.
The student can be educated to hot fomentation to reduce the
thrombophlebitis among patients received intravenous therapy is to be
practiced.
Encourage the students for effective utilization of research based
practice.
IMPLICATION FOR NURSING ADMINISTRATION:
Nursing administrator can formulate protocols and organize continuing
nursing education programme on in-service education programme for
52
health professional regarding the effectiveness of hot fomentation on
thrombophlebitis among patient received intravenous therapy.
Update their knowledge about current practices and to effectiveness of
hot fomentation to reduce the thrombophlebitis through the journals,
conference and seminar.
IMPLICATION FOR NURSING RESEARCH:
As researches promote more research on to assess the management for
thrombophlebitis reduction among patient received intravenous therapy.
Promote effective utilization of research findings on patient who have
thrombophlebitis.
Disseminate the findings of the research through conferences seminars
and publishing in nursing journals.
The study can be conducted in a larger population to generalize the
findings.
LIMITATIONS
Sample size only 60Data collection period is 4 weeks only Study setting is limited to only two hospitals
53
RECOMMENDATIONS
The study recommends the following future research:
The similar study can be conducted in with larger samples for better
generalizations.The study can be conducted two different settings with similar facilities.The study can be conducted in different age group of people.
CONCLUSION:
The purpose of this study was used to assess the effectiveness of hot
fomentation on reducing thrombophlebitis among patient received intravenous
therapy in government and private hospital in Tittagudi. From the above
findings, it evident that hot fomentation is effective in reducing
thrombophlebitis among patients received intravenous therapy.
On the whole, carrying out the present study was really an enriching
experience to the investigator. It also helped a great deal to explore and
improve the knowledge of the researcher and the respondents..
54
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